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Book Review
Upstream: The Quest to Solve Problems Before They Happen by Dan Heath Published & reviewed in 2020 |
July 12, 2020
I learned about Upstream while working out, listening to Brett McKay's March 9 Art of Manliness podcast. It resonated with me because "upstream" work is what I've always done . . . in the language of Steve Covey, "Second Quadrant" things that are important and not urgent.
"Upstream" comes from the analogy Heath gives about fishing drowning kids out of a river, versus going upstream to solve the reason they're falling into the river in the first place.
He points out that upstream work requires extra effort. It requires owning problems that most choose to ignore (like the national debt). It requires working around, or improving upon, perverse incentives like fee-for-services in health care that react to sickness instead of preventing it, or hourly billing that rewards inefficiency and disregards value creation, fixating on efforts instead of results.
It requires innovating new metrics, revenue and compensation models, workflow and project management tools and techniques, professions, and businesses (like Making End$ Meet). It requires getting past narrow personal interest, looking at the bigger picture, and caring enough to do something about it.
Usually with upstream work, in the short term there's no money in it. Compensation wise, the cards are stacked against you, and you wind up leaving a lot of money on the table, being man enough to walk away from perverse incentives, sleeping better with a smaller bank account and a cleaner conscience.
It requires caring about The Greater Good.
It's quietly heroic . . . in terms of results, more heroic than the conspicuous heroism of rescuing drowning kids.
Attention seekers need not apply. This is for people who are interested in doing the most good, not getting the most attention. It's quiet, methodical, patient, persistent, data-driven, far-sighted, circumspect, behind the scenes, and beneath the surface.
I'm going to divide this review into two sections: Favorite Cases, and Favorite Quotes.
I learned about Upstream while working out, listening to Brett McKay's March 9 Art of Manliness podcast. It resonated with me because "upstream" work is what I've always done . . . in the language of Steve Covey, "Second Quadrant" things that are important and not urgent.
"Upstream" comes from the analogy Heath gives about fishing drowning kids out of a river, versus going upstream to solve the reason they're falling into the river in the first place.
He points out that upstream work requires extra effort. It requires owning problems that most choose to ignore (like the national debt). It requires working around, or improving upon, perverse incentives like fee-for-services in health care that react to sickness instead of preventing it, or hourly billing that rewards inefficiency and disregards value creation, fixating on efforts instead of results.
It requires innovating new metrics, revenue and compensation models, workflow and project management tools and techniques, professions, and businesses (like Making End$ Meet). It requires getting past narrow personal interest, looking at the bigger picture, and caring enough to do something about it.
Usually with upstream work, in the short term there's no money in it. Compensation wise, the cards are stacked against you, and you wind up leaving a lot of money on the table, being man enough to walk away from perverse incentives, sleeping better with a smaller bank account and a cleaner conscience.
It requires caring about The Greater Good.
It's quietly heroic . . . in terms of results, more heroic than the conspicuous heroism of rescuing drowning kids.
Attention seekers need not apply. This is for people who are interested in doing the most good, not getting the most attention. It's quiet, methodical, patient, persistent, data-driven, far-sighted, circumspect, behind the scenes, and beneath the surface.
I'm going to divide this review into two sections: Favorite Cases, and Favorite Quotes.
Favorite Cases
- FOT (23-28). The Chicago Public Schools narrowed the solution to their broken system down to one metric, which they call "FOT" (Freshman On-Track).
- CFCs (65-71). Upstream workers made the upstream feel downstream by devising the term, "ozone hole" to simplify what chlorofluorocarbons were doing to the ozone layer, which protects the Earth from ultraviolet radiation that threatens skin health and food supply. This resulted in a global consensus in the 1987 Montreal Protocol and 1992 Copenhagen Amendment that has had a long term reversing effect on ozone depletion.
- Drug-free Iceland (75-82). In the late 1990s, teen drunkenness in Iceland had reached epidemic proportions. Leaders worked together over the next 20 years to change the culture, reducing the rate of teen drunkenness from 42% to 7%.
- Veteran homelessness (90-96). Rockford, Illinois ended veteran homelessness in one year, 2014-2015.
- Chicago crime (116-123). By teaching young men to see themselves as disciplined warriors instead of impulsive savages, in less than three years (2008-2011) the Becoming A Man (BAM) program halved the violent crime rate.
- Y2K (207-213). Y2K (when the calendar flipped from 1999 to 2000) was pretty much a non-event because of all the quiet upstream work that had been done to prepare for it.
- Katrina (213-220). FEMA contractor Innovative Emergency Management (IEM) asked the right question: "Out of all the disasters you're considering, which one keeps you up at night?" FEMA's answer: "A catastrophic hurricane striking New Orleans." The outcome of this question was a response plan IEM developed for FEMA. Despite FEMA's many failures, one thing that went right was "Contraflow" or making all New Orleans interstate traffic outbound. Several Contraflow failures prior to Katrina (and lessons learned) led to success during The Big One. IEM's modeling was strikingly accurate. All of the metrics in the actual event matched their model, except for deaths. In the model, IEM forecast 60,000. Actual deaths, because of the advance warning in IEM's work combined with clumsy Contraflow rehearsals, were 1,100. That's 58,900 lives saved.
Favorite Quotes
- "An ounce of prevention is better than a pound of cure" (17).
- "The escape from problem blindness begins with the shock of awareness that you've come to treat the abnormal as normal" [examples: popularity of C-Sections among Brazilian doctors, or of sexual harassment in the workplace] (37-38).
- "When people experience scarcity - of money or time or mental bandwidth - the harm is not that the big problems crowd out the little ones. The harm is that the little ones crowd out the big ones" (58-59).
- "Saving the day feels awfully good, and heroism is addictive" (62).
- "Escaping the tunnel can be difficult, because organizational structure resists it" (63).
- "The brain is a beautifully engineered get-out-of-the-way machine . . . the add-on utility that allows us to respond to threats that loom in an unseen future is still in beta testing" (64).
- "The entire town (Rockford, IL) had a form of codependency . . . . We were addicted to mediocrity . . . " (90).
- " . . . parenting is a rare exception where upstream thinking comes naturally" (105).
- " . . . when it comes to your health, your ZIP code matters more than your genetic code" (110).
- "The postmortem for a problem can be the preamble to a solution" (124).
- " . . . the social cost of a single gunshot injury is $1.5 million" (126).
- "Most mass shootings are planned at least six months in advance" (147).
- "Upstream work hinges on humility" (185).
- "We micromanage thousands or millions in funds in situations where billions are at stake" (220). (Penny wise and pound foolish.)
- "Be impatient for action but patient for outcomes . . . . Macro starts with micro . . . . Favor scoreboards over pills" (234-237).
Closing Thoughts
Getting Specific, Getting Personal. One theme I noticed in the book that is not neatly contained anywhere in it, within a particular section or chapter, but is more like a thread that runs from end to end, is the significance of getting specific and personal.
Regardless whether the problem was teen alcoholism, homelessness, poverty, or domestic violence, upstream workers gained traction when they started naming names. They didn't just deal with "the homeless" as a category. They focused on individuals.
They didn't just deal with domestic violence victims as a category. They asked, "How are we going to save 's life this week? Where is her stalker, and what is he doing?"
They kept lists in databases, tracked granular metrics on individuals over time, and summarized them to monitor progress.
Cross-Collaboration. Another thread I noticed running through the whole book was how organization departments that had previously operated each in their own isolated silos and in some cases regarded one another as competitors or adversaries, came together and collaborated . . . in many cases face to face, over coffee.
For example: law enforcement, social services, and health care. Imagine what would happen if a cop, a social worker, and a nurse, all of whom were working with the same individual within their own lane, were able to meet for coffee once in a while to compare notes and gain insight. This is consistently what happened in all successful cases.
Especially in the Drug-free Iceland case, it was ALL ABOUT regular meetings between community leaders.
Regardless whether the problem was teen alcoholism, homelessness, poverty, or domestic violence, upstream workers gained traction when they started naming names. They didn't just deal with "the homeless" as a category. They focused on individuals.
They didn't just deal with domestic violence victims as a category. They asked, "How are we going to save 's life this week? Where is her stalker, and what is he doing?"
They kept lists in databases, tracked granular metrics on individuals over time, and summarized them to monitor progress.
Cross-Collaboration. Another thread I noticed running through the whole book was how organization departments that had previously operated each in their own isolated silos and in some cases regarded one another as competitors or adversaries, came together and collaborated . . . in many cases face to face, over coffee.
For example: law enforcement, social services, and health care. Imagine what would happen if a cop, a social worker, and a nurse, all of whom were working with the same individual within their own lane, were able to meet for coffee once in a while to compare notes and gain insight. This is consistently what happened in all successful cases.
Especially in the Drug-free Iceland case, it was ALL ABOUT regular meetings between community leaders.
Respectfully submitted,
Kris Freeberg, Economist
Making End$ Meet
